Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Thursday, February 14, 2008

I've been "saving" this case for a while. I thought that Valentine's Day was the time to present it for your enjoyment.

It will be 2 years this April. I walked in the ER door for my mid-morning shift, not quite awake, and not quite ready for work. As soon as I entered the ER, I heard the nurses talking about a case that they had "saved" for me and laughing as they passed knowing looks between each other.

Anytime I hear this, it instantly pisses me off since it's usually some sort of total cluster-f**k of a case, a crazy patient, a drug seeker, or all of the above.

I picked up the top chart in the rack, and it was an 84 year old lady with at least 15 chief complaints. WONDERFUL.

Down on the list at about #3 or 4 was was that 4 months prior, she thinks she might have fallen on a door knob and it might still be "inside" her.

I sipped my coffee, grabbed a nurse and headed into the room ready to cut the lady off after the first couple of complaints and once again launch into my speech about the purpose and role of the Emergency Department. Surprisingly, when I talked to her, her first couple of complaints related to a vaginal discharge and odor, and the possibility that there might be a door knob up there.

I asked for more details, and she said that in January of that year, she had been stepping over something. She thinks there was a door knob on the floor. Her step across had landed upon newspaper which slid out from under her foot and she came down with her 'devil's den' against the floor. In order to get back up, she had to "ooch around" and thus something might have migrated North for the winter. Since that time, she had been unable to find her priceless antique doorknob, and had noticed a foul personal odor as well as a slight discharge, and an occasional "cold feeling up there".

Now, I thought this lady was off of her rocker. She was all over the place with her idiotic story and had so many other complaints that I thought she was just demented and needed a nursing home for her own safety.

So, I told the RN that we'd just do a speculum exam and thus rule out anything "hiding in the bat cave". As I opened the speculum, I was shocked. There, staring at me was the frickin' hub of a doorknob! The RN saw my face and knew that there really WAS something there!! She did a marvelous job of handing me stuff, keeping her face turned away from the patient, and not looking me straight in the eyes so that she wouldn't completely lose it. She was already vibrating with laughter, and her eyes were tearing with the suppression of her giggles.

I grabbed some ring forceps and got ahold of the hub and then gently broke up the suction and removed the largest door knob I'd ever seen! My God the smell! It was like 'day old meat wrapper meets toilet stall at the men's bathroom of the local high school stadium'. I asked her the story again, but she remained adamant about the slippery newspaper and the "ooching".

I exited the room triumphant with this large antique porcelain doorknob held in my ring forceps!

What I DIDN'T know was that while they were "saving" this case for me, the nurses ordered a pelvic xray! While I was speelunking and looking for the knasty knob (illiteration intended), they were gathered around the xray computer and looking at this image howling with amusement and delight:

Once I got the thing cleaned up, I decided to immortalize it:

The lady was quite appreciative because apparantly, that "cold" sensation was gone, and she was really happy to have her doorknob back! She proceeded to tell me the knob's antique history, and explain why it was so valuable. She wanted to make sure that she could have it back. I saw no reason to send it to Etotheipi's colleagues, so I gave it back to her.

So, I learned a couple of things that morning:a) little old ladies still sometimes like to twiddle their knobb) I've still never heard a credible story about how a foreign object gets into your butt or genitals unless it begins with "I stuck xxxxxxx up my xxxxxx....."c) Porcelain is a very porous stone and will absorb and retain every vile odor knownd) ER Docs can be heros by retrieving and returning little old ladies' favorite antiquese) Sometmes the term "priceless antique" means "you REALLY don't want to buy this, and don't ask any more questions"f) Be nicer to the nurses and bring donuts, or they save cases like this one for you!

I was consulted on a patient who somehow got a turkey baster up his rectum, and couldn't get it to come out. He was a Nascar baseball cap wearin, tobacco chewin, tatooed gentleman, with a vauge story about his hemmorhoids were bothering him, and...

That was probably one of the grossest things I've read on the medblogs... and also one of the funniest! I'm sure it wasn't funny for the involved parties, however. I can't imagine the stench that must have permeated that room. Yikes!! This just proves why I always return...the stories never fail to either amaze or cause a laugh! (Sometimes both!)

I spent a good portion of Easter morning a few years ago retrieving a vibrator from the anal passage of an obviously embarrased middle aged woman. Grabbed it with ringed forceps by the on/off switch. Encouraged her to go straight to sunrise service from the ED.

Poor dear. She was so mortified at "Losing it" and hoping it would fall out, she waited that long to come up with a story. Porr old thang.And "Devil's Den"...her term or your grandmother's? I'm soo using that one! Great post!

Lynn: sorry about the keyboard. As a matter of fact, I did fashion a little "payback". I bought an "Annoy-a-tron" from some internet site. It gave a quick high pitched chirp at varying intervals from 2 to 8 minutes. You couldn't find it since the sound bounced off of everything and it went off at such random intervals, you couldn't pin it down. After a week of frustration, they finally figured out that it was MY prank item and forced me to remove it!

mjrn: I rarely forget the donuts now! Sometimes I when I get off early I'll even bring some back before I go home!

K: great thought!

Shari Ann:...um....uh...um...WOW! Don't know what else to say!

Beth: use household bleach, not the industrial stuff. (No long term damage). Sorry.

erdoc85: My gift from my fiance was a single red rose, a box of chocolate and an electronic fart machine. The rose I found on the dashboard of my car when I was coming home from work this morning. The chocolate he gave me at lunch, the only time we got to see each other, thanks to our odd work hours. The fart machine was laying in my car seat, I found it when I was heading back to work. It had a note attached to it, "baby, I know you've been dying to get your hands on one of these, and what can I say, nothing shows love like a fart machine, use it wisely at work. Happy Valentines Day."

He rocks my world.

I stuck the machine in the nurses station...it was quite funny watching their expressions.

Dude, that's awesome. We video taped some of their reactions, and were going to put it on youtube...but somehow we managed to delete the video off of the camera...so it was a sad ending to a great day. Haha...

i was there for this xray and know exactly the doc who did the exam! we did in fact save this for him....and after that day we were never without donuts again! wonderful doc and priceless story i will never forget!